Half of Postoperative Deaths After Hepatectomy may be Preventable: A Root-cause Analysis of a Prospective Multicenter Cohort Study.

Autor:	Khaoudy I; Department of Digestive Surgery, Amiens, France., Farges O; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Université Paris Clichy, France., Boleslawski E; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France., Vibert E; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France., Soubrane O; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Université Paris Clichy, France.; Department of Digestive Hepatobiliopancreatic Surgery, Hôpital Saint Antoine, Paris, France., Adham M; Department of Digestive Surgery, Hôpital Edouard Herriot, HCL, UCBL1, Lyon, France., Mabrut JY; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Croix Rousse, Lyon, France., Christophe L; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Saint André, Bordeaux, France., Bachellier P; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France., Scatton O; Department of Digestive Hepatobiliopancreatic Surgery, Hôpital Saint Antoine, Paris, France.; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hopital Pitié Salpetrière, Paris, France., Le Treut YP; Digestive Surgery, Hôpital de la Conception, Marseille, France., Regimbeau JM; Department of Digestive Surgery, Amiens, France.; SSPC (Simplification des Soins des Patients Complexes) - Unit of Clinical Research, University of Picardie Jules Verne, Amiens, France.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2018 Nov; Vol. 268 (5), pp. 792-798.
DOI:	10.1097/SLA.0000000000002837
Abstrakt:	Objective: To perform a retrospective root-cause analysis of the causes of postoperative mortality after hepatectomy. Background: Mortality after liver resection has not decreased over the past decade. Methods: The study population was a prospective cohort of hepatectomies performed at hepatic, pancreatic, and biliary (HPB) centers between October 2012 and December 2014. Of the 1906 included patients, 90 (5%) died within 90 days of surgery. Perioperative data were retrieved from the original medical records. The root-cause analysis was performed independently by a senior HBP-surgeon and a surgical HBP-fellow. The objectives were to record the cause of death and then assess whether (1) the attending surgeon had identified the cause of death and what was it?, (2) the intra- and postoperative management had been appropriate, (3) the patient had been managed according to international guidelines, and (4) death was preventable. A typical root cause of death was defined. Results: The cause of death was identified by the index surgeon and by the root-cause analysis in 84% and 88% of cases, respectively. Intra- and postoperative management procedures were inadequate in 33% and 23% of the cases, respectively. Guidelines were not followed in 57% of cases. Overall, 47% of the deaths were preventable. The typical root cause of death was insufficient evaluation of the tumor stage or tumor progression in a patient with malignant disease resulting in a more invasive procedure than expected. Conclusion: Measures to ensure compliance with guidelines and (in the event of unexpected operative findings) better within-team communication should be implemented systematically.
Databáze:	MEDLINE
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